Asian Journal of Transfusion Science最新文献

Background: Sickle cell disease (SCD) patients may develop multiple alloantibodies that pose problem in finding compatible blood for transfusion and require crossmatching with large number of blood.

Aim: The aim of the present study was to find compatible blood with reduced cost by adopting a conservative approach.

Materials and methods: A step-by-step approach using tube technique, antibodies in original serum, and the saved test supernatant (TS) in search of compatible blood for transfusion purposes.

Results: 32 years SCD patient grouped A with multiple antibodies required transfusion. A total of 641 red blood cell (RBC) units of groups A and O were crossmatched using serum and the TS by tube method. Of 138 units tested using the serum at 4°C, 124 units showed direct agglutination in the saline phase and the remaining 14 units were processed through low ionic strength solution (LISS)-IAT, of which 2 units were compatible even by the gel-IgG-card method. The TS, saved from the tests on serum, was used in an identical manner as that of the serum to screen additional 503 units by saline tube method at 4°C units showed direct agglutination of the RBCs of 428 units, hence were removed from inventory for this patient. The remaining 75 units were tested by the LISS-IAT-tube method at 37°C, of which 8 units were found compatible but only 2 units were clear compatible by the gel-IgG-card method. As such, 4 units compatible by the sensitive gel-IgG-card method were issued for transfusion purposes.

Conclusion: The new approach on using the saved TS consumed less of the patient's blood specimen, and the use of the tube method in screening and eliminating a large chunk of incompatible blood units has proved economical if compared with the use of the only gel-IgG-cards device in the entire maneuvering.

Background: Therapeutic plasma exchange (TPE) has been advocated as an adjunct to steroids and cytotoxic drugs in treating patients suffering from vasculitis and presenting with active disease, but we still have insufficient evidence on its effectiveness in improving the clinical response, especially in India. This study was planned to study the clinical outcome in severe vasculitic presentations treated with TPE as an adjunctive therapy.

Materials and methods: A retrospective analysis of TPE procedures performed from July 2013 to July 2017 in the department of transfusion medicine at a large tertiary care hospital was done. All consecutive patients admitted with new diagnosis of systemic vasculitis presenting with active disease and severe presentations such as advanced renal failure or severe respiratory abnormalities or life-threatening vasculitis affecting the gastrointestinal tract, neurological and musculoskeletal system; who needed TPE for removal of preformed antibodies, were included in the study.

Results: There were a total of 31 patients in whom TPE was performed for severe systemic vasculitis; 26 adults and five pediatric. Six patients tested positive for perinuclear fluorescence, 13 for cytoplasmic fluorescence (cANCA), two for atypical antineutrophil cytoplasmic autoantibody, seven for anti-glomerular basement membrane antibodies, two for antinuclear antibodies (ANA), and one patient tested positive for ANA as well as cANCA before the augmentation of TPE. Out of 31, seven patients showed no clinical improvement and succumbed to the disease. At the end of desired number of procedures, 19 tested negative and five tested weak positive for their respective antibodies.

Conclusion: Favorable clinical outcomes were observed with TPE in patients with antibody-positive systemic vasculitis.

Isaacs syndrome is a disease characterized by nerve hyperexcitability and pseudomyotonia and treated with immunomodulatory and symptomatic therapy approaches. Here, we report a case of anti-(leucine-rich glioma-inactivated 1) antibody-positive patient diagnosed as Isaacs syndrome and accomplished a nearly complete response to only four sessions of therapeutic plasma exchange (TPE). Our experience suggests that TPE along with other immunomodulatory agents may be beneficial and well-tolerated approach in patient with Isaacs syndrome.

Context: Yellow phosphorus (YP) 3% is one of the rodenticides available, which is a potent hepatotoxin and it is fatal. Management of YP poisoning is difficult since there is no antidote available; only definitive management is liver transplantation. Therapeutic plasma exchange (TPE) helps the YP poisoning patients by removing the poison or its metabolite or the inflammatory mediators released in the body in response to toxin.

Aims: To determine the role of TPE in rat killer (YP) poisoning.

Settings and design: This was a descriptive period study conducted from November 2018 to September 2020.

Subjects and methods: Sixteen consecutive YP poisoning patients were included in the study (n = 16). A total of 48 sessions of TPE were carried out. Liver function tests such as serum glutamic-oxaloacetic transaminase, SGPT, total bilirubin, and direct bilirubin as well as coagulation profile such as prothrombin time, activated partial thromboplastin time, and international normalized ratio were analyzed at the time of admission, after each TPE session, and at the time of discharge.

Statistical analysis used: The results were recorded, and it was analyzed statistically by SPSS version 17.

Results: Liver function tests improved significantly from the time of admission and after each TPE and at the time of discharge (P < 0.05). Coagulation profile improved statistically (P < 0.05). Thirteen patients were improved in their clinical status, and three patients left the hospital citing personal reasons.

Conclusions: TPE could potentially bridge the gap between medical management and liver transplantation in cases of YP poisoning.

Background and objectives: The present study was conducted to evaluate the etiology of altered color of plasma component of blood in transfusion practice.

Materials and methods: The study was conducted at the blood center of a tertiary care teaching hospital in western India for a period of 6 months. After component separation, all the plasma units with altered color were segregated and samples were taken for further evaluation. Altered colored plasma units were divided into three - green discoloration, yellow discoloration, and lipemic plasma. Donors were called, their detailed history was taken, and necessary investigations were done accordingly.

Results: Forty plasma units out of 20,658 (0.19%) donations showed discoloration. Out of which, 3 plasma units showed green discoloration, 9 plasma units showed yellow discoloration, and the remaining 28 plasma units were lipemic. Among three donors whose plasma showed green discoloration, one female donor had a history of oral contraceptive pill usage and had higher values of copper and ceruloplasmin. All donors with yellow plasma had a higher value of unconjugated bilirubin. All the donors with lipemic plasma gave a history of intake of fatty meal prior to donating blood and showed higher values of triglyceride, cholesterol, and very-low-density lipoprotein.

Conclusion: Plasma component with altered color restricts its issue to the patient and also for use in fractionation. In our study, many of the altered color plasma units were safe to transfuse, but the decision regarding transfusion was debatable on consultation with the treating doctor. Further studies with a large sample size are recommended for the use of these plasma components.

Introduction: Autoimmune hemolytic anemia is characterized by increased red cell destruction and/or decreased red cell survival due to autoantibodies directed against self-antigens on red cells. Since autoantibodies react with self and nonself red blood cells (RBCs), they tend to mask the underlying clinically significant alloantibodies and many a times mimic a specific pattern like alloantibodies.

Materials and methods: We discuss three immune hematological cases of warm autoantibodies. Antibody screening was performed by solid-phase red cell adherence (SPRCA) technique on a fully automated platform NEO Iris (Immucor Inc., USA). In case of a positive antibody screen, antibody identification was performed using SPRCA, NEO Iris (Immucor Inc., USA). Alloadsorption for adsorbing the autoantibodies was done using in-house prepared allogenic packed RBCs - R1R1, R2R2, and rr.

Results: All cases had warm autoantibody with a broad specificity against self-Rh antigens. Anti "C" and Anti "e" antibodies were identified in case 1 and autoanti "e" antibody in cases 2 and 3. Case 3 had underlying alloanti "E" along with autoanti "e" which posed a transfusion challenge.

Conclusion: Our case series highlights the importance of detecting the nature of the antibody whether it is alloantibody or autoantibody with antigen specificity. This would help in selecting appropriate antigen negative blood units for transfusion purpose.

Background and aims: When determining ABO antibody titers, immunoglobulin G (IgG) antibodies can be masked by immunoglobulin M (IgM) antibodies. Hence, the measurement of actual concentration of IgG requires methods like heat inactivation (HI) of plasma. This study was aimed at determining the effects of HI on IgM and IgG titers performed by conventional tube technique (CTT) and column agglutination technique (CAT).

Materials and methods: This was a prospective, observational study conducted from October 2019 to March 2020. All consecutive A, B, and O group donors who gave consent for participation were included. All samples were consecutively tested by CTT and CAT, before and after HI (pCTT, pCAT).

Results: A total of 300 donors were included. IgG titers were found to be more than IgM titers. For group O, IgG titer results were higher for both anti-A and anti-B compared to group A and B. For group A, B, and O, pretreatment results were higher than posttreatment IgG titer results. Median anti-A titers were similar to median anti-B titers across all categories. Median IgM and IgG titers were higher for group O individuals than nongroup O individuals. There was reduction in IgG and IgM titers after HI of plasma. One log reduction in median titers was observed when ABO titers were performed by CAT and CTT.

Conclusion: There is one log difference between median antibody titers estimated using heat inactivated and nonheat inactivated plasma. The use of HI for ABO isoagglutinin titer estimation can be considered in low resource settings.

Background: von Willebrand disease is a common inherited bleeding disorder caused by the deficiency of von Willebrand factor (vWF).^[1] The levels of vWF depend on several factors, including exercise, hormones, and ABO blood type.^[2] This study was planned to evaluate plasma vWF levels and factor VIII (fVIII) levels in healthy blood donors and its association with the ABO blood group.

Aims: The aim of this study was to evaluate plasma vWF levels and fVIII levels in healthy donors and its association with the ABO blood group.

Methods: This study was done in 2016 healthy adult blood donors. Complete history and relevant examination were done along with ABO and Rh (D) blood group typing, complete blood count, prothrombin time, activated partial thromboplastin time, vWF antigen (Ag) level, fVIII coagulant assay, and other tests for hemostasis.

Statistical analysis used: Data were expressed in proportions and mean, median, and standard deviation, respectively. An appropriate test of significance was applied. P < 0.05 was considered statistically significant.

Results and conclusions: vWF level of donors ranged from 24 to 186 IU/dL with a mean of 96.31 IU/dL. Low vWF Ag level (below 50 IU/dl) was found in 2.5% of donors while 0.1% (2/2016) had level <30 IU/dL. O Rh (D)-positive blood group donors had the lowest vWF level (87.85 IU/dL), while ARh (D)-negative donors had the highest vWF level (117.27 IU/dL). fVIII level of the donor population ranged from 22% to 174%, with a mean of 98.82%. About 2.48% of donors had fVIII levels below 50%. There was a statistically significant correlation between fVIII level and vWF level (P < 0.001).